David Kernick’s rather unpromisingly titled Theoretical framework for multimorbidity1 is a hidden gem punching far above its weight. Don’t be deceived. It repays careful and repeated reading and reflection, an effort well rewarded. The theory is apposite and cutting-edge, pulling together many threads in current generalist thinking in and out of general practice both lucidly and with a constant eye on how they can be useful in practice.
The systems theory model (metaphor, heuristic) of simple-complicated-complex systems, is fairly well known for Martin Marshall for example, but is here extended to include those ideas from chaos and complexity that have proved such useful tools in the consultation and in healthcare delivery, principally around the idea of complex adaptive systems. There are also echoes of those other tripartite ideas, the Hippocratic ‘cure sometimes, relieve often, comfort always’ and Heath and Sweeney’s Technical, evidentiary, and reflective generalism. Kernick picks up the point which was nagging me, that perhaps it is the simple that is a special reductionist case of the complex and chaotic rather than the reverse. He also picks up in his conclusion on the political implications, both governmental and Foucauldian.
It was especially good to read this in the generalist context of your editorials and the articles of Martina Kelly2 and Emyr Gravell,3 and good to note that reflective general practice is still alive and well in Exeter.
- © British Journal of General Practice 2012
